Depression-Heart Risk Link Strongest in Younger Women

Action Points

Note that this observational cohort study suggested an association between depression at the time of coronary angiography and adverse cardiovascular events in women less than age 55.

Be aware that dedicated studies in this age group will be needed to confirm this association and establish causality.

Among patients undergoing coronary angiography, younger women appeared to be most at risk for poor cardiovascular outcomes associated with depression, researchers found.

Having moderate-to-severe depressive symptoms was associated with about double the likelihood of having coronary artery disease detected in women 55 and younger (OR 2.02, 95% CI 1.03-3.97), but not in other age-sex groups, according to Amit Shah, MD, of Emory University in Atlanta, and colleagues.

The younger women also were more than twice as likely to die during follow-up (HR 2.45, 95% CI 1.05-5.73) and to have a major adverse cardiovascular event (HR 2.17, 95% CI 1.20-3.96) when at least moderate depressive symptoms were detected, with similar results seen only in men 65 and older, the researchers reported online in the Journal of the American Heart Association.

Pointing to similar findings in previous studies, the authors wrote, "As a whole, these studies suggest that young women may be especially susceptible to the cardiovascular consequences of psychosocial risk factors, especially depression."

And that had important clinical implications, "as young women have significantly higher post-myocardial infarction mortality than young men," the authors wrote. "More attention should be paid to depression in this high-risk group, especially because less than 20% of depressed post-MI patients (in general) receive pharmacologic treatment."

"Although treatment for depression has yet to show a significant benefit in the prognosis of coronary artery disease, particularly among women, emerging data suggest that stress reduction customized for women could be helpful in this respect," they noted.

Shah and colleagues explored the issue focusing on younger women, who have higher rates of depression and are more likely to die following MI compared with men of similar age. The analysis included 3,237 patients (34% women; mean age 63) who were undergoing elective or emergent coronary angiography and were included in the Emory Cardiovascular Biobank.

Depressive symptoms were assessed on the day of angiography using the Patient Health Questionnaire-9 (PHQ-9). At least moderate depression was indicated by a score of at least 10 out of 27.

The highest rate of moderate-to-severe depression was found in women 55 and younger (27%) and the lowest was found in men 65 and older (9%).

In the overall sample, there was no significant association between depressive symptoms and the presence of coronary artery disease. But the finding varied by age and sex such that after multivariate adjustment for coronary artery disease risk factors, demographics, and the reason for angiography, each 1-point increase on the PHQ-9 was associated with a greater likelihood of having coronary disease in women 55 and younger (OR 1.07, 95% CI 1.02-1.13), but in no other age-sex groups.

The patients were followed for a median of 2.9 years, and during that time 27% of patients had at least one major adverse cardiovascular event (MACE), which was a composite of death, MI, or revascularization.

In the overall cohort, each 1-point increase on the PHQ-9 was associated with greater risks of death (HR 1.05, 95% CI 1.03-1.06) and MACE (HR 1.04, 95% CI 1.02-1.05), although the relationships were only statistically significant in younger women and men 65 and older.

The authors acknowledged some limitations of the study, including the possibility of selection and referral bias, the uncertain generalizability to other centers and the general population, the potential for residual confounding, and the inability to establish causality using an observational design.

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